Fertile men can father children throughout their adult lives unlike women whose fertility declines with age. Infertility was once considered a “female problem”: however, we now know that up to half of all cases have a male component. The semen analysis is one of the most important fertility tests and should be done before beginning any female treatments.
Sperm are manufactured in the testicles and travel through the epididymis and the vas deferens during ejaculation. Sperm require three months to develop so a semen analysis done today is reflective of conditions that affected the sperm during the previous three months.
Causes of Male Infertility
Environmental
Sperm quality can be reduced if the testicles are exposed to elevated temperatures for prolonged periods. The scrotum expands to cool the testicles by moving them further from the body and it contracts to increase the temperature. Activities like prolonged sitting in a hot tub, wearing clothing that is too tight, or occupations requiring long periods of sitting can interfere with temperature regulation and reduce fertility.
Smoking, excessive drinking, exposure to heavy metals, marijuana, chemotherapy, radiation and other factors can decrease fertility. In most cases of environmentally caused male infertility, normal fertility returns once the cause is addressed. Certain heavy metals, chemotherapy, or radiation may cause permanent damage. We advise freezing sperm prior to cancer treatments.
Medical Causes of Male Infertility
Male infertility can be caused by a varicocele, which is a mass of varicose veins in the spermatic cord. Blood circulates through these veins thus cooling or warming the testicles and a varicocele interferes with this function.
A complete evaluation should be done before concluding that infertility is due to a varicocele. Small to moderate varicoceles often don’t have a significant impact on sperm quality. Large varicoceles may decrease sperm quality and can usually be treated by a urologist (surgery for varicocelectomy) or a radiologist (interventional procedure requiring spring placement).
A man may develop antibodies to his sperm (rarely) usually as a result of testicular trauma or a vasectomy. When this occurs the immune system tries to destroy sperm as if they were bacteria or viruses.
Some men have a vasectomy as a permanent means of birth control. See our vasectomy page for a description and reversal options.
Treatments
Mild male infertility can often be treated with intrauterine insemination (IUI) while moderate to severe male factor is usually treated with IVF and ICSI.
There is no effective drug treatment to improve sperm quality and quantity. Clomid and FSH have been used to treat male infertility but they must be administered for at least three months, are extremely expensive, and improvements in sperm parameters are often minor. The exception is the rare male that has severe deficiencies of FSH and LH, a condition known as hypogonadotropic hypogonadism.
To the best of our knowledge, all of the male infertility products touted on the Internet have little or no clinical effectiveness.
Fortunately, with today’s technologies most men suffering with male infertility, can father genetically related children. Since the advent of intracytoplasmic sperm injection (ICSI), a pregnancy can be initiated when as few as one sperm can be obtained. Prior to ICSI, the only option for patients with moderate to severe male infertility was to use a sperm donor.
